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Dr. A. Jean Ayres, an occupational therapist with advanced training in neurosciences and educational psychology, developed the theory of sensory integration to explain the relationship between deficits in interpreting sensory information from the body and the environment and difficulties with academic and motor learning (Bundy & Murray, 2002).
Ayres' primary objective when developing the theory of sensory integration was to explain the underlying cause of sensorimotor and learning problems in children in order to determine the optimal mode of intervention (Ayres, 1972; 1979). In the first publication of the theory in 1972 Dr. Ayres postulated that learning is a function of the brain and that disordered sensory integration accounts for some aspects of learning disorders and that enhancing sensory integration will make academic learning easier (Sensory Integration and Learning Disorders, 1972).
In 1989 sensory integration was defined as "the neurobiological process that organises sensation from one's own body and from the environment and makes it possible to use the body effectively within the environment. The spatial and temporal aspects of inputs from different sensory modalities are interpreted, associated, and unified. Sensory integration is information processing" (Ayers, 1989; p.9).
Since then a great body of research has been published on sensory integration and its potential application to diverse populations. In fact the theory of sensory integration has sparked more research and controversy than any other theory developed by an occupational therapist.
The tactile system is the largest sensory system and plays a major part in determining human physical, mental, and emotional behaviour. Touch sensations flow into the brain to tell us that something is touching us and play an important role in body awareness and movement.
The tactile system is important for:
● Recognising shape and texture of objects
● Identifying whether a stimulus is painful or dangerous
● Planning movements
● Development of fine more skills & manipulation of objects
● Emotional security
● Social skills
The word proprioception refers to the sensory information that we receive from our joints and muscles. This information is telling us about the position, movement, force, and direction needed for activities such as buttoning clothes, writing, screwing a lid on a jar or playing with a toy without breaking it.
The proprioceptive system is important for:
● Development of an internal map of our body (body scheme)
● Body awareness
● Motor control and motor planning
● Emotional security
The vestibular system is locate in our inner ear and is giving us information about where we stand in the world. It tells us where we are in relation to gravity; whether we are moving or standing still, and how fast or slow we are going.
The vestibular system is important for:
● Physical activities such as running, climbing, dancing
● Coordination of the two sides of the body
● Knowing where we are going
● Seeing clearly while moving
The visual system helps us to navigate in the world and judge the speed and distance of objects and people.
The visual system is important for:
● Following a moving object with our eyes
● Writing letters and numbers
● Fitting pieces into jigsaw puzzles and cutting along lines
● Copying from the blackboard or from books
The auditory system is located in our ear and relates to the ability to receive sounds.
The auditory system is important for:
● Locating sounds in the environment
● Discriminating between sounds and words such as "ba" and "ma"
● Attending to, understanding, or remembering what is read or heard
● Making up rhymes and singing
● Speaking and articulation
Smell plays an important role in establishing and receiving memories and associations that influence some of our choices and preferences, such as a specific type of perfume or a certain type of soap. A baby can recognise his mother just through smell and our food choices are greatly dependent upon the sense of smell.
Taste helps us to survive and provides us with essential information about bitter, salty, sweet, and sour flavours. These tastes are important in our selection of food or to inform us whether certain tastes might be harmful for our body.
A. Jean Ayres (1972) defined praxis as the learned ability to plan and direct a temporal series of coordinated movements toward achieving a result - usually a skilled and non-habitual act.
Under the light of sensory integration theory, praxis is viewed as a uniquely human skill that enables the brain to conceptualise, organise, and direct purposeful interactions with the world (Ayres, 1985). Praxis includes knowing what to do as well as how to do it and is fundamental for skills such as getting dressed, learning to write, or playing.
Occupational therapists who view praxis from a sensory integrative perspective are concerned with the individual’s sensory processing and conceptual abilities (Ayres, 1985; Ayres et al., 1987).
Praxis includes 3 components (Ayres, 1989)
● Ideation - knowing what to do
● Motor planning - directing and organising the movement
● Execution - carrying out the motor plan
Praxis and dyspraxia are complex concepts, and the terminology associated with them can be confusing. In a simple manner:
● Dyspraxia is a generic term that refers to developmentally based disorders of praxis with a variety of etiologies
● Sensory integrative- based dyspraxia refers to the praxis problems that have their bases in poor sensory processing
(Reevs & Cermark, 2002)
If praxis does not emerge, the result is Sensory-based Motor Disorder - dyspraxia, a developmental motor planning disorder. Sensory-based Dyspraxia is one of the most common manifestations of Sensory Processing Disorder in children with learning disorders or other developmental delays.
Sensory-based Motor Disorder - dyspraxia is a brain dysfunction that hinders the organisation of sensory information and interferes with the ability to motor plan. The nature of the disorder indicates that the problem begins early in the child's life and affects his development as he grows (Ayres, 2005).
In accordance with Sensory Integration theory, two levels of dysfunction in praxis have been identified:
Bilateral Integration and Sequencing Deficit: is a mild form of Sensory-based Motor Disorder that involves:
● Difficulty using the two sides of the body in a co-ordinated manner & sequencing motor tasks
● Poor vestibular & proprioceptive processing
● Difficulty in formulating action plans; a problem with the motor-planning of new, rather than habitual, movements
● Poor tactile, vestibular & proprioceptive processing
Some characteristics of poor motor planning are listed below. The following characteristics include some of the symptoms of a problem in praxis.
● Difficulty planning and organising the sequences of movements in activities such as cutting with scissors or riding a bicycle
● Difficulty with daily activities such as getting dressed, using knife and fork
● Tendency to bump into and/ or trip over things
● Taking longer to learn skills such as tying shoelaces, writing letters or numbers, catching a ball
● Poor gross motor control when running, climbing, jumping, and going up and down stairs
● Doing things in inefficient ways
● Low self-esteem
● Difficulty when transitioning from one activity to another
(Source: Ayres, 2005; Kranowitz, 2003)
Modulation of sensory input is critical to our ability to engage in daily life activities. Filtering of sensations and attending to those that are relevant and attending attention to task requires a good level of sensory modulation (Lane, 2002). When modulation is inadequate, the child's attention may be continually diverted to ongoing changes in the environment and this may interfere with learning and play. Current research is examining Sensory Modulation Disorder (SMD) as a valid clinical syndrome (Miller et al. 2007)
Some characteristics of poor sensory modulation are listed below. The following characteristics include some of the symptoms of a problem in sensory modulation.
● Aversion or struggle when picked up, hugged, or cuddled
● Aversion to certain daily life activities, including baths or showers, cutting of fingernails, haircuts, face washing and dental work
● Responding with aggression to light or unexpected touch to arms, face, legs
● Avoidance of certain styles or textures of clothing (e.g. scratchy)
● Avoidance of play activities that involve body contact
● Dislike getting hands in sand, finger-paint, paste
● Exaggerated fear of falling or heights
● Become anxious when feet leave the ground
● Seem particularly slow at movements
● Avoid jumping down from higher surfaces
● Avoid climbing, escalators, or elevators
● Seem to misunderstand what is said
● Have difficulty looking and listening at the same time
● Seem distracted if there is a lot of noise around
● Hold hands over ears
● Gag easily with food in mouth
● Picky eater
● Mouth objects
● Express discomfort with light
● Rock unconsciously
● Become overly excitable during movement activities
● Be "on the go"
● Be slower than others to respond to sensation
(Ayres, 2005; Lane, 2002; Dunn, 1999)
"A sensory integrative problem may interfere directly with the learning process in the brain, or it may cause poor behaviour that interferes with schoolwork"
For most children, sensory integration develops in the course of ordinary childhood activities. But for some children, sensory integration does not develop as efficiently as it should. When the process of sensory integration is disordered, a number of problems in learning, development, and/ or behaviour may become evident (Sensory Integration International, 1991).
Sensory Processing Disorder (SPD) manifests itself in two major ways: poor praxis and poor modulation (Bundy & Murray, 2002).
Sensory Processing Disorder (SPD) may exist on its own, or it may coexist with:
● Attention Deficit and Hyperactivity Disorder (ADHD)
● Asperger's Syndrome
● Fragile X Syndrome
● Autistic Spectrum Disorder (ASD)
● Pervasive Developmental Disorder (PDD)
● Cerebral Palsy (CP)
● Spina Bifida
● Nonverbal Learning Disorder (NLD)
Some Common Signs and Symptoms of Sensory Processing Disorder
"A child with sensory processing disorder often develops in an uneven way"
● Hyperactivity and distractibility
● Delays in speech and language
● Low muscle tone and coordination problems
● Slow development of motor skills
● Poor organisation of behaviour
● Learning difficulties at school
● Sensitivity to movement, touch, sights, sounds, and smells
● Poor organisation skills in adolescence
(Ayres, 2005; Sensory Integration International, 1991)
"The belief that a child will outgrow his problem...may prevent him from getting professional help at the age that it will do the most good"
"Therapy involving therapeutic sensory experiences...can be more effective than drugs, psychological analysis, or rewards and punishment in helping the brain and body to develop optimally"
During Sensory Integration Therapy, the child is guided through activities that challenge his or her ability to respond appropriately to sensory input by making a successful organised response (SII, 1991). Therapy takes place in a safe and interesting environment and through the use of specialised suspended equipment the child is afforded the opportunity to integrate sensations arising from the vestibular, proprioceptive, tactile, visual, and auditory systems. Treatment is developed in collaboration with the child and aims at meeting the child's specific needs for development. The activities are also designed to elicit autonomic responses and are graded to lead
to higher levels of organisation that will promote the child's interaction with the environment. Specific skills training is not part of sensory integration treatment, rather activities are used to help the child develop the underlying abilities that are necessary for learning and mastering of skills.
Therapy using sensory integration as a frame of reference is dynamic and fun for the child. The clinical setting is safe and provides the child with the opportunity to explore appealing pieces of equipment: platforms to swing on, barrels to climb through, trapezes to swing from, and big blocks to climb over. The therapist and the child engage in a play situation where the child is motivated to seek new experiences and under the guidance of the trained professional to achieve success that probably would not occur in unguided play. The playful atmosphere incorporates opportunities for the child to take in enhanced sensation and promotes adaptive interactions with the environment.
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